telemedicine of saos- - aamr
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Modifier le texte. Seguimiento clinico del paciente con CPAP: u?lidad de la telemedicina Clinical follow-‐up of pa.ent treated
by CPAP: use of telemedicine
Prof P.Escourrou Centre de Médecine du Sommeil Hôpital Béclère, Clamart, France
Background
• Over the past ten years, there has been a significant growth in the number of people tested for OSA.
• This can be aRributed to a number of different factors. – greater awareness of sleep disorders, including OSA, in the general popula?on.
– expanding popula?on of elderly and obese popula?ons. • These factors have resulted in increased tes?ng and treatment for OSA which payers have experienced as an increase in spending for sleep disorders.
New policies to cut costs of diagnosis and treatment of sleep disorders.
• Use of ambulatory sleep tes?ng to diagnose OSA in place of in-‐center polysomnography.
• Use of Auto-‐PAP to ?trate the pa?ent in place of an in-‐center PAP ?tra?on.
• Use of primary care and na?onal providers of ambulatory diagnosis in place of local board cer?fied sleep physician providers.
• Use of na?onal Home Care Providers chains in place of local HCP.
• Stricter control on the use of CPAP.
Place for telemedicine of SDB in Europe?
• Telemedicine for diagnosis? • Telemedicine for treatment and follow-‐up? • How to bill for telemedicine? • Telemedicine program for other applica?ons than OSA?
Management of Obstruc?ve Sleep Apnea in Europe I.Fietze, Sleep Medicine 2011, on behalf of the COST Ac?on B26 Group
Management of Obstruc?ve Sleep Apnea in Europe I.Fietze, Sleep Medicine 2011, on behalf of the COST Ac?on B26 Group
• There is no concensus on the diagnos?c procedure in Europe: ambulatory or in hospital/center
• There is consensus (90.5%) on the necessity for CPAP therapy follow-‐up
• But reimbursement only takes place in 14/19 countries (73.7%).
• Aher ?tra?on, the follow-‐up intervals within the first half-‐year to year vary extensively.
• Some?mes,the exper?se of the aRending physician is required
Telemedicine for Diagnosis of OSA J F Masa, Thorax 2011
ROC for Home Resp Polygraphy Vs. In lab PSG
Cost of telema6c HRP vs non-‐telema6c HRP in % of in lab PSG
CPAP treatment: The clinical path
Sleep Specialist
Home care Providers
Pa6ent
Med Device Manufacturers
Health care organisa?on
Treatment Follow-‐up
clinics
Diagnosis Prescrip.on
Reimbursement Linked to use (minimal compliance)
Reference Treatment : CPAP
• Efficient treatment requires more than 3hrs of use/night • The first 3 months are crucial for the long-‐term compliance
Con?nuous Posi?ve Airway Pressure
Telemedicine of CPAP treatment in France:
• Nb of pa?ents with CPAP: > 400.000 • Cost of treatment:
– 414 millions euros (2009) – Increase between 2007 and 2009: 40%
• Indica?ons for CPAP: AHI > 30/h(PG) or respiratory arousals>10/h (PSG) • Treatment follow-‐up: HCP covered by Social Security
– CPAP device, mask and maintenance – Educa?on – 2 home visits/yr and report transmission to physician – Rate: 20 €/week i.e. 1040 €/year – Star?ng october 1st 2013 : mandatory teleobservance transmiRed to « Caisse Na?onale d’Assurance Maladie » mean 3h/night/28 days
objectives • Set up an interoperable telemedicine system for the follow-up of
patients with sleep apnea syndrome. • Combine data from Continuous Positive Airway Pressure devices,
and clinical patient data, into the e-health sleep record. • Develop technical and clinical alerts based on the data to trigger ia
technical interventions or a clinic visit. • Improve patient compliance via an interactive training tool targetting
patient education about CPAP use • Study the health economic impacts of telemonitored CPAP devices
and of the telemonitoring services.
Consor?um
Consor6um: -‐ Réseau Morphée (Sleep Health Network) -‐ Assistance Publique-‐Hôpitaux de Paris -‐ Resmed (manufacturer) -‐ Philips – Respironics (manufacturer) -‐ Orkyn’ (Home care provider) -‐ Santéos (Informa?on system) -‐ Adverbia -‐ Acsen?s
Associate Members: -‐ DGCIS (Ministry of Industry) -‐ ARS (Agence Régionale de Santé) -‐ SFRMS (société de Recherche sur le Sommeil) -‐ Pa?ents groups: FFAIR, Sommeil et Santé
Medico-‐economical evalua?on Design :Randomized Control Trial
200 pts OSAS
J 0
No tele-‐ monitoring
randomisa?on
Tele-‐ monitoring
100 pts 100pts
M1
Home visit alerts
Daily monitoring
Home visit adjustments
Home visit
Clinic adjustements Clinic
M3 PSG
Compliance
• Primary end-‐point: compliance/ night at 3 months
• Secondary end-‐points: – Comparison of costs – Residual somnolence – Residual AHI with CPAP
• Par.cipants: 12 sleep centers in Paris region
Developping exper?se
• Revised care pathways: beRer communica?on between health care professionals, improved reac?vity and beRer alloca?on of ressources
• Telefollow-‐up: technical/medical alarms • ini?al follow-‐up: 3 months • annual follow-‐up: periodic transmission
• Increasing pa?ent autonomy via improved pa?ent educa?on
A generalizable solu?on
• Na?onal deployment : capitalisa?on and mutualisa?on – For the same sleep disease: OSAS
• other HCP, other prescribers • Service Plaqorm:
– Home Telediagnosis : Polygraphy, Polysomnography – Teleexper?se: help for diagnosis and follow-‐up – Teletreatment: serngs of the Medical Device
A generalizable solu?on
– For other diseases at home: • Non-‐invasive Ven?la?on • Heart Failure • Renal dialysis
– Telemedicine in Europe • COPD, Hypertension… • medico-‐economical study: MAST • Thérapeu?c Educa?on : « serious game »
The problems
• Local reglementa?on: ARS autorisa?on in France
• payment of the HCP and the Health Professionnals
• Integra?on to device specific sohware already in use: need for industry partnerships
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